Transcript Session 1: Responding to Unwarranted Clinical Variation: A Case Jean-Frederic Levesque Chief Executive, Bureau of Health Information Session 1: Responding to Unwarranted Clinical Variation –

Session 1: Responding to Unwarranted
Clinical Variation: A Case
Jean-Frederic Levesque
Chief Executive, Bureau of Health Information
Session 1: Responding to Unwarranted
Clinical Variation – A Case Study
Measuring Stroke Mortality Variation: What We Learned
19 June 2014
NSW Health Symposium
Jean-Frederic Levesque, MD, PhD
Chief Executive
December 5th release: 30-day mortality
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Insights into Care report
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Hospital profiles
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Up to 21 pages of content for each hospital
Spotlight on measurement
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Acute myocardial infarction, ischaemic stroke,
haemorrhagic stroke, pneumonia, hip fracture surgery
NSW results and variation within the state
Discussion of the approach and sensitivity analyses
Technical supplement
Why are we reporting this measure?
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Mortality following hospitalisation is reported internationally as part of
performance assessments.
Mortality ratios provide a piece of the picture and are complementary to
other quality and safety measures.
Mortality data is influenced by the performance of local systems,
not just hospitals, and of multidisciplinary teams.
RSMRs are screening tools that provide an indication of where further
assessment may be needed.
Public reporting of mortality results can catalyse improvements in
comprehensiveness and appropriateness of care for patients.
What is this measure about?
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It compares the ‘observed’ number of deaths in the 30-days
following admission with the number of ‘expected’ deaths.
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Deaths occurring in-hospital and after discharge are counted using
linked data sets.
A statistical model is used to calculate the ‘expected’ number of
deaths based on the age, sex and comorbidities of patients.
Cases are attributed to their first presenting hospital during an
episode of care.
The findings are not appropriate for comparing or ranking
hospitals or for identifying avoidable deaths.
Overview of the results
Overview of the results
Funnel plot Ischaemic Stroke
Ischaemic stroke 30-day risk-standardised mortality ratio, NSW public hospitals, July 2009 – June 2012 ∆ μ
(∆) Patients are assigned to the first admitting hospital in their last period of care. Data for hospitals with an expected mortality of < 1 are supressed.
(μ) Hospitals with < 50 patients are not reported publicly. Deaths are from all causes, in or out of hospital. Data exclude AMI STEMI-not specified (ICD-10-AM I21.9).
Source: SAPHaRI, Centre for Epidemiology and Evidence NSW Ministry of Health.
Analysis by peer group Ischaemic stroke
Ischaemic stroke 30-day risk-standardised mortality ratio, by peer group July 2009 – June 2012
Hospital profile: Summary dashboard
Hospital profile: Stability of results
Following the report’s release
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Various hospitals have considered the results and identified where
improvements could be made.
Results were reviewed alongside other quality and safety measures,
such as clinical audit and review panels.
Eight clinical settings contacted us to obtain clarifications on the
measures or more detailed information.
Future provision of updates and complementary analyses will be
provided.
What have we learned?
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Mortality is an easily understood outcomes that requires very
sophisticated methods to be reported in a fair way
Understanding contextual and system-level factors is important in
developing mortality measures (e.g. impact of transfers)
Partnering with clinical leaders supports the development of
clinically-relevant measures and the rigorous validation
Internal and public reporting of information acts in synergy to raise
awareness and catalyse assessments
Outcomes that are sensitive but crucial for patients can be part of
the range of measures reported publicly to support accountability
and meaningful discussion
Acknowledgements
• Kim Sutherland, Director, System and Thematic Reports,
Bureau of Health Information
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Doug Lincoln, Lead Analyst, Bureau of Health Information
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Sadaf Marashi-Poor, Senior Analyst, Bureau of Health
Information
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Kerrin Bleicher, Analyst, Bureau of Health Information
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Sally Prisk, Graphic Designer, Bureau of Health Information
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All BHI staff